Provider Demographics
NPI:1497568802
Name:ELISHEBA OF MT ZION
Entity type:Organization
Organization Name:ELISHEBA OF MT ZION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:QETURAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-325-7313
Mailing Address - Street 1:105 TURRET LN APT 3
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4377
Mailing Address - Country:US
Mailing Address - Phone:757-325-7313
Mailing Address - Fax:
Practice Address - Street 1:105 TURRET LN APT 3
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4377
Practice Address - Country:US
Practice Address - Phone:757-325-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty